Transcript High Risk Stickers A safer way to practice?

High Risk Stickers
A safer way to practice?
Brendan Healy
Consultant in Infectious Diseases and
Microbiology
High Risk Stickers
• High risk (HR) specimens should be labelled
with a HR yellow sticker in accordance with
laboratory standard operating procedures
(SOPs) [2].
• COSSH – Employers have a duty to protect
employers from harm. Doctors have a duty to
inform laboratory staff of potential hazardous
samples
What are the risks?
Blood borne viruses (BBVs) are transmitted by entry of blood or
other bodily fluids containing viruses into the body of a susceptible
person.
BBVs of main concern:
• Hepatitis B
• Hepatitis C
• Human Immunodeficiency Virus (HIV)
All these viruses are in ACDP Hazard Group 3 and therefore are
considered high risk [4].
Infected individuals with BBVs may not show symptoms or even be
aware that they are carrying it.
Avoid the risk – Universal Precautions
•
Risk assessment
•
COSHH – Under COSHH requirements, if the risk assessment shows that there is
a risk of exposure to biological agents, and effective vaccines exist, these should
be offered to those not already immunised
•
Immunisations
•
Personal protective equipment (PPE) - (HSE, 2001) recommends that “gloves
should be worn for all work with material known or suspected of containing
hazard group 3 biological agents”[4]
•
Biochemistry designated high risk area
Results
% of patients truly HR compared to % of patients
inappropriately labelled HR
35%
65%
Inappropriately labelled HR
HR
In a cohort of 200 patients, 65% were truly HR and 35%
were inappropriately labelled HR.
Truly HR, 37% Hep C, 32% HIV, 27% Hep B, 4% Mixed BBVs.
Results
% Patients inappropriately labelled HR
4%
17%
no clear reason
possible reasons
no specimens
79%
Results
Possible reasons why non-HR patients were inapproriately
labelled as HR (T=Tested, NT=Not Tested for BBVs)
17%
4%
4%
4%
50%
4%
17%
MRSA Pos, T
VRE, NT
Group A strep, T
Syphilis Pos, NT
HEP C AB False Pos
Past HEP B or C, T
Results
There was no clear reason why some non-HR
patients were inappropriately labelled as HR
2%
5%
BBV test carried out
26%
No BBV test carried out
67%
BBV test carried out as
part of Pregnancy Screen
Paeds oncology patient,
no BBV test carried out
Avoid the risk – Universal Precautions
• Risk assessment
• Immunisations
• Personal protective equipment (PPE) - (HSE,
2001) recommends that “gloves should be worn
for all work with material known or suspected of
containing hazard group 3 biological agents”[4]
Lumley